Vaginal bleeding

Last updated: Thursday, 17, February, 2011
CausesAppropriate Tests

Diagnosis based on clinical assessment, including: age of patient, sexual activity, and relationship of bleeding to menstrual cycle.

Consider possibility of miscarriage of pregnancy (including ectopic) in any woman of child bearing age. See under Abortion and Ectopic pregnancy

Cervical cytology in all sexually active patients, and in all patients over 25 years of age.

FBC, blood film if bleeding heavy and/or prolonged.
See Iron deficiency

See also Vaginal discharge


Uterine/cervical abnormalities, especially

  • Fibroids
  • Polyps
  • Adenomyosis
  • Endometriosis
  • Endometrial hyperplasia
  • Carcinoma
Endometrial biopsy (curettage). Lesion biopsy if appropriate.

High, unopposed endogenous oestrogen levels


See Ovarian mass

Other disorders

Dysfunctional bleeding

Common; diagnosis of exclusion.

Bleeding disorder

See under Bleeding disorder

Post-coital, intermenstrual bleeding

Endometrial biopsy (curettage); lesion biopsy if appropriate.

Cervical abnormalities, especially

  • Cervical ectropion
  • Cervicitis
  • Carcinoma
See Cervical lesion

Oral contraceptives, especially

  • Progesterone-only preparations

Uterine abnormalities

  • Fibroids
  • Intra-uterine contraceptive device
  • Carcinoma

Vaginal abnormalities, including

  • Retained tampon


See also Vaginal discharge

Post-menopausal bleeding

Hysteroscopic examination and endometrial biopsy; lesion biopsy if appropriate.

Uterine/cervical abnormalities, especially

  • Carcinoma
  • Sarcoma
  • Polyps
  • Atrophic change